| NPI | 1538448204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: KS 2854) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MO 2018016495) |
| Enumeration Date | 2011-08-11 |
| Last Update Date | 2021-02-10 |